Provider Demographics
NPI:1568883213
Name:ANDREW B. GILBREATH, D.D.S., PLLC
Entity Type:Organization
Organization Name:ANDREW B. GILBREATH, D.D.S., PLLC
Other - Org Name:PUGET SOUND FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:BENJAMIN
Authorized Official - Last Name:GILBREATH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:206-999-8942
Mailing Address - Street 1:15515 3RD AVE SW STE F
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-2553
Mailing Address - Country:US
Mailing Address - Phone:206-243-5445
Mailing Address - Fax:206-243-0128
Practice Address - Street 1:15515 3RD AVE SW STE F
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-2553
Practice Address - Country:US
Practice Address - Phone:206-243-5445
Practice Address - Fax:206-243-0128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-26
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA11087261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental